Analysis of Risk Factors of Infection in Patients with Inflammatory Bowel Disease

Overview

Journal Prz Gastroenterol

Publisher Termedia

Date 2025 Jan 13

PMID 39802969

Authors

Alicja Jakubowska

Dorota Szydlarska

Grazyna Rydzewska

Affiliations

Soon will be listed here.

Abstract

Introduction: infection (CDI) is one of the most important challenges in contemporary gastroenterology. However, data from CDI studies are sometimes contradictory.

Aim: To analyse the risk factors for CDI in patients with inflammatory bowel disease (IBD).

Material And Methods: This is a retrospective analysis of the medical records of 204 patients (77 IBD with CDI, 50 with IBD without CDI, and a control group of 77) hospitalised in a referral centre in Warsaw. Data were entered and analysed by using univariate logistic regression models.

Results: Patients with IBD and CDI had significantly longer hospitalisation time than patients with IBD without CDI. The population of patients with CDI and IBD was statistically significantly younger ( < 0.001). Patients with IBD and CDI had a lower body mass index ( < 0.001) and were more often treated with antibiotics ( < 0.001). Prior antibiotic use (< 1 month) was a risk factor for CDI ( = 0.003). Lower body mass index ( < 0.001) and lower levels of albumins ( = 0.036) were strong risk factors for CDI in the study group. Additional risk factors were young age ( < 0.001), length of hospitalisation ( = 0.001), treatment with glucocorticosteroids ( = 0.001), immunosuppressive treatment ( = 0.001), and gastritis and/or duodenitis ( = 0.002). The study did not confirm that proton pump inhibitors or biologic treatment affected the risk of CDI.

Conclusions: The risk factors for CDI in patients with IBD include younger age, female gender, low body mass index and hypoalbuminaemia, use of thiopurines, antibiotics, and glucocorticosteroids, prolonged hospitalisation, and gastritis and/or duodenitis.

References

Leffler D, Lamont J . Clostridium difficile Infection. N Engl J Med. 2015; 373(3):287-8. DOI: 10.1056/NEJMc1506004. View

Barletta J, Kanji S, MacLaren R, Lat I, Erstad B . Pharmacoepidemiology of stress ulcer prophylaxis in the United States and Canada. J Crit Care. 2014; 29(6):955-60. DOI: 10.1016/j.jcrc.2014.06.025. View

Murthy S, Steinhart A, Tinmouth J, Austin P, Daneman N, Nguyen G . Impact of Clostridium difficile colitis on 5-year health outcomes in patients with ulcerative colitis. Aliment Pharmacol Ther. 2012; 36(11-12):1032-9. DOI: 10.1111/apt.12073. View

Crobach M, Planche T, Eckert C, Barbut F, Terveer E, Dekkers O . European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2016; 22 Suppl 4:S63-81. DOI: 10.1016/j.cmi.2016.03.010. View

Zacharioudakis I, Zervou F, Pliakos E, Ziakas P, Mylonakis E . Colonization with toxinogenic C. difficile upon hospital admission, and risk of infection: a systematic review and meta-analysis. Am J Gastroenterol. 2015; 110(3):381-90. DOI: 10.1038/ajg.2015.22. View

Dial S, Delaney J, Barkun A, Suissa S . Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA. 2006; 294(23):2989-95. DOI: 10.1001/jama.294.23.2989. View

Turner N, Anderson D . Hospital Infection Control: . Clin Colon Rectal Surg. 2020; 33(2):98-108. PMC: 7042016. DOI: 10.1055/s-0040-1701234. View

Bauer M, Notermans D, van Benthem B, Brazier J, Wilcox M, Rupnik M . Clostridium difficile infection in Europe: a hospital-based survey. Lancet. 2010; 377(9759):63-73. DOI: 10.1016/S0140-6736(10)61266-4. View

Loo V, Bourgault A, Poirier L, Lamothe F, Michaud S, Turgeon N . Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med. 2011; 365(18):1693-703. DOI: 10.1056/NEJMoa1012413. View

10.

Issa M, Ananthakrishnan A, Binion D . Clostridium difficile and inflammatory bowel disease. Inflamm Bowel Dis. 2008; 14(10):1432-42. DOI: 10.1002/ibd.20500. View

11.

Gu Y, Zhang M, Sun J, Lv K, Zhong J . Risk factors and clinical outcome of Clostridium difficile infection in patients with IBD: A single-center retrospective study of 260 cases in China. J Dig Dis. 2017; 18(4):207-211. DOI: 10.1111/1751-2980.12461. View

12.

Jodorkovsky D, Young Y, Abreu M . Clinical outcomes of patients with ulcerative colitis and co-existing Clostridium difficile infection. Dig Dis Sci. 2009; 55(2):415-20. DOI: 10.1007/s10620-009-0749-9. View

13.

Pant C, Madonia P, Minocha A . Does PPI therapy predispose to Clostridium difficile infection?. Nat Rev Gastroenterol Hepatol. 2009; 6(9):555-7. DOI: 10.1038/nrgastro.2009.128. View

14.

Aseeri M, Schroeder T, Kramer J, Zackula R . Gastric acid suppression by proton pump inhibitors as a risk factor for clostridium difficile-associated diarrhea in hospitalized patients. Am J Gastroenterol. 2008; 103(9):2308-13. DOI: 10.1111/j.1572-0241.2008.01975.x. View

15.

Kundrapu S, Sunkesula V, Jury L, Cadnum J, Nerandzic M, Musuuza J . Do piperacillin/tazobactam and other antibiotics with inhibitory activity against Clostridium difficile reduce the risk for acquisition of C. difficile colonization?. BMC Infect Dis. 2016; 16:159. PMC: 4835867. DOI: 10.1186/s12879-016-1514-2. View

16.

Peng J, Shen J, Zhu Q, Ran Z . The impact of Clostridum difficile on surgical rate among ulcerative colitis patients: A systemic review and meta-analysis. Saudi J Gastroenterol. 2015; 21(4):208-12. PMC: 4542418. DOI: 10.4103/1319-3767.161644. View

17.

Kariv R, Navaneethan U, Venkatesh P, Lopez R, Shen B . Impact of Clostridium difficile infection in patients with ulcerative colitis. J Crohns Colitis. 2011; 5(1):34-40. DOI: 10.1016/j.crohns.2010.09.007. View

18.

Ananthakrishnan A, McGinley E, Saeian K, Binion D . Temporal trends in disease outcomes related to Clostridium difficile infection in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2010; 17(4):976-83. DOI: 10.1002/ibd.21457. View

19.

Dalton B, Lye-Maccannell T, Henderson E, Maccannell D, Louie T . Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low-endemicity, non-outbreak hospital setting. Aliment Pharmacol Ther. 2009; 29(6):626-34. DOI: 10.1111/j.1365-2036.2008.03924.x. View

20.

Jen M, Saxena S, Bottle A, Aylin P, Pollok R . Increased health burden associated with Clostridium difficile diarrhoea in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2011; 33(12):1322-31. DOI: 10.1111/j.1365-2036.2011.04661.x. View